Critical Levels – Details, episodes & analysis

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Critical Levels

Health & Fitness

Education

Frequency: 1 episode/41d. Total Eps: 57

Hosted by paramedic Zach Cantor, "Critical Levels" is a new podcast dedicated to having critical conversations in paramedicine. "Critical Levels" is a podcast for paramedics, by paramedics, with a Canadian and local bias.

Please visit our website - http://www.criticallevels.ca - for more information

Please email us at info@criticallevels.ca for any suggestions/feedback/comments

Follow us on Twitter: @criticalevels

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Data updated on 13/09/2026

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Score global : 68%

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Death, Taxes, and Shift Work - Dr. James Gilbertson

Season 1 · Episode 57

Friday, April 3, 2026 • Duration 01:13:43

Shift work is a core part of paramedicine, but growing evidence shows it carries real long-term health risks.

In this episode, with Dr. James Gilbertson, we explore the science behind circadian rhythm disruption, the impacts of sleep deprivation, and how lifestyle and longevity medicine can help mitigate risk.

Key Topics Covered:

Why shift work affects lifespan and health outcomes
Circadian rhythm disruption explained
Links between shift work and:
- Cardiovascular disease
- Cancer risk
- Mental health challenges
Sleep optimization strategies for shift workers
Exercise and longevity evidence
Nutrition approaches that work on shift
Social connection and cognitive health
Practical, realistic habits for paramedics

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In Flight Medical Emergencies - Dr. Carvalho

Season 1 · Episode 56

Saturday, February 28, 2026 • Duration 42:59

In this episode of Critical Levels, Zach sits down with Dr. Anna-Maria Carvalho, a Royal College–certified emergency physician with a subspecialty in aviation medicine, to unpack what really happens when someone asks, "Is there a medical professional on board?"

From the physiology of flying at 36,000 feet to the realities of managing cardiac arrest in a cramped aircraft cabin, this episode tackles the fears, logistics, and practical considerations of in-flight medical emergencies—especially for paramedics, nurses, and physicians who may be called upon to help.

✈️ What We Cover

🫁 The Physiology of Flight

Why cabin altitude means we're all mildly hypoxic (normal sats ~92–93%)
How hypoxia increases heart rate, blood pressure, and sympathetic tone
Why alcohol hits harder in the air
Why tomato juice tastes better at altitude
The risk of DVTs and who's most vulnerable
Barotrauma, ear pain, and when a perforated eardrum can occur

🚨 In-Flight Medical Emergencies

Incidence: ~1 in 600 flights
Most common categories:
- Neurologic
- Cardiac
- Respiratory
- Gastrointestinal
The realities of flying with chronic disease
Why more emergencies are happening as more people travel

🧰 What's in the Emergency Medical Kit?

AED (separate from the medical kit)
Oxygen & Ambu bag
Oral airways (intubation equipment varies by airline)
IV supplies (limited fluids, but enough for medication administration)
Medications: epinephrine, steroids, bronchodilators, benzodiazepines, antipsychotics, glucose agents, and more
BP cuff (palpated pressures only—too noisy to auscultate!)
Pulse oximeter (remember: 93% can be normal)

📡 Ground-Based Medical Support

Most airlines consult 24/7 emergency physicians on the ground
Volunteers don't make diversion decisions—the captain does
Diversions involve significant operational and logistical consequences
In-flight volunteers are there to assess, stabilize, and communicate

🫀 Cardiac Arrest at 36,000 Feet

Move to a bulkhead/galley if possible
Call for additional medical volunteers
Early AED use
CPR until ROSC, exhaustion, or medical futility
Diversion decisions are collaborative and situational

⚖️ The Legal Question

Good Samaritan protections apply
Act within scope
No gross negligence or willful misconduct
No one has ever been successfully sued for assisting with an in-flight medical emergency
You are not responsible for diversion decisions

🕊️ When Death Occurs In Flight

Resuscitation attempts may cease when appropriate
Diversion is not automatic
Flight crew are trained to manage these situations professionally and discreetly

🔑 Key Takeaways

You already have the skills.
The environment is different—but the fundamentals are the same.
Recognizing sick vs. not sick is incredibly valuable.
Most in-flight volunteer diagnoses are ultimately confirmed in hospital.
About 60% of passengers improve with basic stabilization.
You are protected when acting in good faith and within scope.

If you've ever hesitated to answer that overhead call, this episode may change your perspective.

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The First 60 - Where Every Minute Counts

Season 1 · Episode 55

Thursday, January 29, 2026 • Duration 01:44:50

On this unique episode, we attend the First60 Toronto Resuscitation Conference and interview several of the speakers. For more detailed information, check out our website, criticallevels.ca

AHA Guidelines - Not Godlines: Drs. Cheskes & Drennan

Season 1 · Episode 54

Saturday, November 29, 2025 • Duration 01:12:57

In this episode, Zach sits down with Dr. Ian Drennan and Dr. Sheldon Cheskes to dissect the newly released 2025 AHA and ILCOR resuscitation guidelines. They break down the evidence, controversies, and real-world implications for paramedic practice.

Key Topics Covered

🔹 How guidelines are actually created
🔹 Mechanical CPR
🔹 Heads-Up CPR

🔹 IV vs IO Access

🔹 Medications
🔹 Defibrillation Science

🔹 Airway Management
🔹 Post Cardiac Arrest Care

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Waveforms Don't Lie - Danny and Rance (DnR)

Season 1 · Episode 53

Sunday, October 19, 2025 • Duration 01:03:40

In this episode, we explore the science, history, and frontline application of End-Tidal CO₂ (ETCO₂) — a tool that offers real-time insight into ventilation, perfusion, and metabolism. Danny and Rance from DnR explain how paramedics can use ETCO₂ to assess and guide care across multiple patient presentations.

Key Takeaways:

ETCO₂ is the sixth vital sign — reflecting ventilation, perfusion, and metabolism in real time.
Capnography vs. Oximetry: SpO₂ shows what was happening; ETCO₂ shows what's happening now.
Waveform interpretation: Alpha and beta angles reveal underlying pathology like bronchospasm, obstruction, or air trapping.
Clinical uses:
- Tube confirmation: Real-time verification in 6 breaths or less.
- CPR: Values <10 mmHg after 20 mins indicate poor prognosis.
- Ventilation: Real-time feedback for rate and volume.
- Head injuries: Maintain normocapnia; hyperventilate only during herniation.
- Sepsis, trauma, PE, and DKA: Trending ETCO₂ helps identify metabolic and perfusion problems.
Practical tips:
- "Filter first, end-tidal to the sky."
- Inline sensors outperform sidestream for accuracy.
- End-tidal is not just for intubated patients — use it with nasal prongs for sedation and respiratory monitoring.

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Pearson MCI: Lessons Learned - Darren and Colin

Season 1 · Episode 52

Friday, September 26, 2025 • Duration 43:15

Delta Air Crash: Paramedics on the Frontline of a Mass Casualty Incident

In this gripping episode of Critical Levels, host Zach Cantor sits down with Ornge Critical Care paramedics Colin and Darren to discuss their response to the February 2025 Delta crash at Toronto's Pearson International Airport.

From the initial plume of smoke spotted mid-flight to interagency coordination on the ground, they share how training, adaptability, and teamwork guided decisions under extreme pressure.
Key Topics:
• First impressions from the air and immediate decision-making
• Mass casualty triage in an unpredictable environment
• The challenges of communication across multiple agencies
• The value of leadership, adaptability, and humility under stress
• Interdisciplinary and interagency debriefs: lessons learned
• Mental health, recovery, and supporting paramedics after major incidents

Takeaway:
Mass casualty incidents test every part of the emergency response system. Preparation, communication, and collaboration—not just within one service, but across all responders—make the difference.

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What's a Paramedic - Dr. Alan Batt

Season 1 · Episode 51

Sunday, June 29, 2025 • Duration 01:06:01

What is a paramedic — really?

In this thought-provoking episode of Critical Levels, Zach sits down with Dr. Alan Batt to unpack the evolving identity, responsibilities, and future of the paramedic profession. Together, they explore the disconnect between what paramedics are trained for versus what they actually do, the consequences of outdated education models, and the urgent need for professionalization and system-level change.

They discuss:

Why current training doesn't match real-world workload
How we define scope, identity, and autonomy in modern paramedicine
The concept of career pathways beyond clinical work
What regulatory independence could look like
And why it might finally be time for paramedics to "move out of their parents' basement"

Whether you're a frontline clinician, educator, leader, or student, this episode challenges assumptions and sparks a critical conversation about the future of paramedicine in Canada and beyond.

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Neonates - Anthony Iacolucci

Season 1 · Episode 50

Friday, May 30, 2025 • Duration 01:02:26

Neonates are one of the most feared patient populations in EMS—and for good reason. In this episode, Zach Cantor talks with Anthony Iacolucci, a pediatric respiratory therapist and paramedic, about how to confidently approach neonatal calls.

Anthony introduces NEO SECRETS, a practical acronym covering the top 10 causes of neonatal illness, and offers insight into assessment, common pitfalls, and key treatment considerations.

NEO SECRETS Breakdown:

• N – Inborn errors of metabolism

• E – Electrolyte abnormalities

• O – Overdose or toxic exposure

• S – Sepsis (the leading cause of neonatal mortality)

• E – Endocrine crisis (e.g., hypoglycemia, adrenal insufficiency)

• C – Cardiac conditions (cyanotic vs. acyanotic presentations)

• R – Recipe or formula mishaps (e.g., dilution errors leading to hyponatremia)

• E – Enteric emergencies (e.g., malrotation with volvulus, gastroenteritis)

• T – Trauma, including accidental and non-accidental injuries

• S – Seizures (often subtle and hard to recognize in neonates)

Key Takeaways:

• Neonates are not small adults or even small pediatric patients—they are physiologically distinct and highly vulnerable.

• Early identification of sepsis, cardiac issues, and metabolic errors can save lives.

• Paramedics should rely on strong assessment skills, detailed history-taking, and high suspicion for uncommon causes.

• Videos, glucose checks, pre-ductal saturations, and detailed caregiver interviews are essential field tools.

Data-Driven Resuscitation & Seamless Transitions

Season 1 · Episode 49

Monday, March 31, 2025 • Duration 52:53

In this episode of Critical Levels, we dive into the cutting-edge strategies shaping pre-hospital and emergency department care. Our guests discuss how data-driven decision-making, high-performance CPR, and improved handover processes are revolutionizing patient outcomes.

Key Topics Covered:
✅ High-Performance CPR: The role of real-time feedback, mechanical CPR devices, and quality metrics in improving survival rates.
✅ Data-Driven Protocols: How data influences resuscitation techniques, including push-dose epinephrine, early vasopressor administration, and optimizing CPR pauses.
✅ Seamless Transitions of Care: Addressing the challenges of pre-hospital to hospital handover, minimizing interruptions, and ensuring continuity of life-saving interventions.
✅ Training & Coaching: The impact of structured CPR coaching, debriefing sessions, and real-time monitoring in refining paramedic performance.
✅ Future Directions: Exploring nurse-led ACLS, multidisciplinary teamwork, and technology-driven improvements in emergency medicine.

Key Takeaways:
🔹 Data analysis is critical in refining protocols and enhancing patient survival.
🔹 Effective communication and structured handovers reduce adverse events.
🔹 Continuous training and feedback loops lead to better resuscitation outcomes.

Join us as we explore how collaboration, innovation, and data are shaping the future of emergency medical care.

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K9 Medicine - Dr. Jason Donohoe

Tuesday, March 4, 2025 • Duration 54:34

🔹 Key Topics:

🔸 Why medics need to understand K9 trauma care

The overlap between human and canine emergency medicine
Common injuries in police, military, and search-and-rescue dogs

🔸 MARCH for Canines—What's Different?

The first "M" stands for Muzzle—securing the dog's "weapon" before treatment
Understanding the similarities in trauma care between humans and dogs
Key differences in how canines respond to injury and shock

🔸 Massive Hemorrhage Control—Why Tourniquets Don't Work on Dogs

Anatomical challenges—why dogs' limbs aren't suited for tourniquets
When to use direct pressure, wound packing, and hemostatic agents
Junctional bleeding—where life-threatening hemorrhages happen in dogs

🔸 Airway & Breathing—Why Intubating a Dog Is Easier Than You Think

How to recognize respiratory distress vs. normal panting
Why dogs have larger, straighter airways than humans
Needle decompression for pneumothorax—landmarks and technique

🔸 Transporting an Injured K9—Avoid These Mistakes

Best positions and vehicles for safe transport
What paramedics, police, and handlers need to plan for before an emergency

🔸 Shock & Fluid Resuscitation—The Critical Role of Femoral Pulse Checks

How to assess perfusion in a dog without a blood pressure cuff
Why EZ-IO is the best choice for vascular access in canines
When and how to administer fluids, TXA, and blood products

🔸 CPR for Dogs—Does It Work?

When CPR can save a dog—and when it won't
How to perform chest compressions correctly
Naloxone for K9 opioid overdoses—it works, but dosing is different

🔸 Medications & Pain Management—What Paramedics Can Safely Use

Critical Levels – Details, episodes & analysis

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Critical Levels – Details, episodes & analysis

Podcast details

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Apple Podcasts

Spotify

Shared links between episodes and podcasts

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Latest published episodes

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